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When Discriminating Patients Become Insulting

May 29, 2007

In today’s times when the average person is often bombarded by images and news of “bad” hospitals “detaining” patients who cannot pay for hospital bills and “evil” doctors who are money-hungry or out to “kill” patients, people have begun developing a general mistrust of doctors. It is as if every doctor they’d encounter will give them haphazardly done medical service and then squeeze out all the money from their pockets. And this growing mistrust of doctors is hindering our efforts to improve our country’s provision of health care.

I never thought that I’d be seeing such overly-suspicious and stubborn patients until one 24-hour duty in a hospital emergency room, I encountered one. Well, actually, she’s the patient’s “mother”. Being in the Philippines, we have come to “accept” the fact that Filipinos have developed the bad habit of going to the emergency room seeking outpatient clinic services (follow-up consult after treatment of urinary tract infections, requesting lab referrals for pre-employment physical exams because they don’t have the “time” during the weekdays, which is rather unbelievable because it’s a pre-employment medical exam and it means they’re jobless so they have all the time available, etcetera).

In this case, the overly-suspicious and stubborn person (which I will call “Mara”) brought her 4-year old “son” because of some coughing, cold, and a low-grade fever. After some tests, it turned out that the kid has only a mild respiratory tract infection. I prescribed a 7-day course of Amoxicillin 250 mg/5mL syrup 5 mL every 8 hours and a paracetamol for fever. Mara argued that the dose I prescribed was not enough. I asked her why she thought so.

Here’s how our conversation went (translation is italicized and enclosed in parenthesis):

Mara: Sigurado ba talaga kayo diyan sa nireseta ninyo? Hindi ba under-dose ‘yan? Dati kasi 7.5 mL ‘yung pinainom ko sa kanya. Di ba dapat ganun din ang ibigay ngayon? (Are you sure about your prescription? Isn’t it an under-dose? I used to give him 7.5 mL. Isn’t it that is what should be given now?)

Me: Amoxicillin din ba ‘yung gamot na ginamit dati? 250 mg/5mL din ba ‘yung formulation? (Was the drug used Amoxicillin? The formulation was 250 mg/5mL?)

Mara: Amoxicillin din ‘yung dati. Sigurado ako. (It was Amoxicillin. I’m sure of it.)

Me: Based kasi sa weight ng anak ninyo ngayon na 19.5 kg, dapat 5 mL lang ang ibigay. 7.5 mL is more than what is usually given. Baka nag-lose siya ng weight? Actually, mabigat pa din siya ngayon for his age. (Based on your son’s present weight, which is 19.5 kg, only 5 mL of Amoxicillin should be given. 7.5 mL is more than what is usually given. Maybe he lost weight? Actually, he’s still heavy for his age.)

Mara: Hindi naman siya pumayat. Ganyan pa din naman siya katulad ng dati. (He did not lose weight. He’s still the same.)

Me: What was his weight?

Mara: Hindi ko matandaan. (I don’t remember.)

Me: Well, nakita ninyo naman na tinimbang siya ngayon. 19.5 kg siya. And eto, ipapakita ko sa inyo ‘yung computation na ginagamit namin para i-compute ang gamot na ibinibigay. (Well, you saw that your son was weighed and it is 19.5 kg. And here, I’ll show you how we compute the medications that we prescribe.)

(Author shows Mara the formulary and computes the dose of amoxicillin using a calculator in front of her. Author shows her the final computation, as outlined on paper).

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Written by Prudence · Filed Under Health, Medicine, Personal 

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